Chronic Stenotrophomonas maltophilia infection and exacerbation outcomes in cystic fibrosis

Waters, Valerie; Atenafu, Eshetu G.; Salazar, Juliana Giraldo; Lu, Annie; Yau, Yvonne; Matukas, Larissa; Tullis, Elizabeth; Ratjen, Felix

doi:10.1016/j.jcf.2011.07.008

« Previous Next »Journal of Cystic Fibrosis
Volume 11, Issue 1 , Pages 8-13, January 2012

Chronic Stenotrophomonas maltophilia infection and exacerbation outcomes in cystic fibrosis☆☆☆★

Valerie Waters
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada M5G 1X8
- Corresponding author at: Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel.: +1 416 813 7654x4541; fax: +1 416 813 8404.
Eshetu G. Atenafu
- Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, Toronto, Canada M5G 2M9
Juliana Giraldo Salazar
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada M5G 1X8
Annie Lu
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada M5G 1X8
Yvonne Yau
- Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada M5G 1X8
Larissa Matukas
- Division of Microbiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Canada M5B 1W8
Elizabeth Tullis
- Division of Respirology and Keenan Research Centre of Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Canada M5B 1W8
Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada M5G 1X8

Received 30 May 2011; received in revised form 8 July 2011; accepted 24 July 2011. published online 22 August 2011.

Abstract

Background

Chronic Stenotrophomonas maltophilia infection is a risk factor for pulmonary exacerbation in cystic fibrosis (CF) but its impact on subsequent clinical outcomes is unknown. The aim of this study was to determine the effect of chronic S. maltophilia infection and associated antimicrobial therapy on the recovery of forced expiratory lung volume in 1s (FEV₁) following pulmonary exacerbation.

Methods

This was a retrospective cohort study of patients with CF followed at The Hospital for Sick Children and St. Michael's Hospital from 1997 to 2008. The primary outcome was the difference in FEV₁ percent predicted from baseline to follow up after a pulmonary exacerbation. Secondary outcomes for the effect of antimicrobial therapy included time to subsequent exacerbation.

Results

There were 1667 pulmonary exacerbations in 440 CF patients. Patients with chronic S. maltophilia infection did not recover their baseline FEV₁ following 31% of exacerbations and had an overall mean FEV₁ decline of 1.84% predicted after exacerbation. Older (p=0.02), female (p=0.02) patients with lower BMI z score (p=0.002) and Burkholderia cepacia complex infection (p=0.005), but not chronic S. maltophilia infection (p=0.86), had a greater decrease in follow up FEV₁% pred compared to baseline. The number of days of antibiotic therapy against S. maltophilia during a pulmonary exacerbation was not associated with a significant difference in the FEV₁ recovery (p=0.69) or with a longer time to subsequent pulmonary exacerbation (p=0.56).

Conclusions

Although CF patients experience a significant decline in lung function following exacerbation, chronic S. maltophilia infection and associated antimicrobial therapy do not affect subsequent lung function recovery.

Abbreviations: ABPA, allergic bronchopulmonary aspergillosis, BMI, body mass index, CF, cystic fibrosis, FEV₁, forced expiratory volume in 1s, MRSA, methicillin resistant Staphylococcus aureus